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Celiac Disease and Portal Hypertension: A Causal Association or Just a Coincidence?

Amit Tanwar1, Gaurav K Gupta1, Virender Chauhan1

  • 1Department of Gastroenterology, SMS Medical College and Hospital, Jaipur, India.

Journal of Clinical and Experimental Hepatology
|July 14, 2020
PubMed

Insights

Celiac disease (CD) is prevalent in patients with portal hypertension (PHT), particularly in cryptogenic liver disease and noncirrhotic PHT. Screening for CD is recommended in liver disease patients due to its higher likelihood.

Area of Science:

  • Gastroenterology
  • Hepatology
  • Immunology

Background:

  • Celiac disease (CD) has been anecdotally linked to portal hypertension (PHT).
  • The etiological association between CD and PHT remains unproven.
  • This study investigates the prevalence of CD in PHT patients across various etiologies.

Purpose of the Study:

  • To determine the prevalence of celiac disease (CD) in patients diagnosed with portal hypertension (PHT).
  • To explore the association between CD and different causes of PHT, including chronic liver disease (CLD) and noncirrhotic PHT (NCPHT).

Main Methods:

  • A prospective observational study was conducted from June 2017 to December 2018.
  • Patients with PHT (CLD and NCPHT) were screened for CD using IgA anti-tTG antibody tests.
  • Serology-positive patients underwent duodenal biopsy for confirmation.

Main Results:

  • Out of 464 PHT patients, 29 were diagnosed with CD.
  • CD prevalence was 4.5% in chronic liver disease (CLD) patients and 14.6% in noncirrhotic PHT (NCPHT) patients.
  • CD was notably found in patients with cryptogenic CLD (cCLD) and noncirrhotic portal fibrosis (NCPF).

Conclusions:

  • Celiac disease (CD) is common in patients with portal hypertension (PHT) of diverse etiologies.
  • The prevalence of CD is significantly higher in liver disease patients compared to the general population.
  • Routine screening for CD is advised in patients with PHT, especially those with cryptogenic CLD, NCPHT, and autoimmune hepatitis.
Abstract

Keywords:
AIH, autoimmune hepatitisANA, anti-nuclear antibodyASMA, anti-smooth muscle antibodyAnti LKM, anti-liver kidney microsome antibodyBCS, Budd–Chiari syndromeCD, celiac diseaseCLD, chronic liver diseaseEHPVO, extrahepatic portal vein obstructionHBV, hepatitis B virusHBs Ag, hepatitis B surface antigenHLA, human leukocyte antigenIg G, immunoglobulin GNCIPH, noncirrhotic idiopathic portal hypertensionNCPF, noncirrhotic portal fibrosisNCPH, noncirrhotic portal hypertensionPHT, portal hypertensionc CLD, cryptogenic chronic liver diseaseceliac diseasechronic liver diseasenoncirrhotic portal hypertensionportal hypertensiontTG antibody, tissue transglutaminase antibody

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